March 16, 2005

Depression, The Lawyers' Epidemic: How You Can Recognize the Signs

Depression is a dangerous disease, and lawyers are more prone to it than members of any other profession. Consider these numbers:

A 1990 study at Johns Hopkins University found that of 28 occupations studied, lawyers were the most likely to suffer depression, and were more than 3.6 times more likely than average to do so. A Harrison Barnes, Builders and Destroyers (citing W.W. Eaton, J.C. Anthony, W. Mandel & R. Garrison, Occupations and the Prevalence of Major Depressive Disorder, 32 J. Occupational Med. 1079 (1990).

A research study of 801 lawyers in the State of Washington found that 19% suffered from depression. Barnes, supra (citing G.A.H. Benjamin, E.J. Darling & B.D. Sales, The Prevalence of Depresion, Alcohol Abuse, and Cocaine Abuse Among United States Lawyers, 13 J. Law & Psychiatry 233 (1990).

A quality-of-life survey by the North Carolina Bar Association in 1991 revealed that almost 26% of respondents exhibited symptoms of clinical depression, and almost 12% said they contemplated suicide at least once a month. Michael J. Sweeney, The Devastation of Depression.

Left untreated, depression can be fatal. According to the National Institute of Mental Health, 15% of people with clinical depression commit suicide. Don P. Jones & Michael J. Crowley, "I wish I would have called you before...." Surveys of lawyers in Washington and Arizona showed that most lawyers suffering from depression also have suicidal thoughts. Joan E. Mounteer, Depression Among Lawyers, 33 Colo. Lawyer 35 (Jan. 2004). One study found that lawyers have a much greater risk of acting on their suicidal thoughts and succeeding in doing so. Id. Suicide ranks among the leading causes of premature death among lawyers. Richard G. Uday, That Frayed Rope, Utah State Bar J., Aug./Sept. 2003 (citing Meyer J. Cohen, Bumps in the Road, GPSOLO, July/Aug. 2001, at 20). The 1992 Annual Report of the National Institute of Occupational Safety and Health reported that male lawyers are twice as likely as the general population to commit suicide. Lynn Johnson, Stress Management, Utah State Bar J., Jan./Fed. 2003.

Why are lawyers more prone than anyone else to this dangerous disease? Psychologist Lynn Johnson points to two personality traits many lawyers have: perfectionism and pessimism. Johnson, Stress Management.

It's no secret that the legal profession attracts perfectionists and rewards perfectionism. Perfectionism drives us to excel in college, in law school, and on the job. But perfectionism has a dark side; it can produce "a chronic feeling that nothing is good enough." Johnson, Stress Management. Perfectionists "are driven by an intense need to avoid failure.... [T]hey are unable to derive satisfaction from what ordinarily might be considered even superior performance." Don P. Jones & Michael J. Crowley, "I wish I would have called you before ..." (citing Blatt, Sidney J., Ph.D. “The Destructiveness of Perfectionism: Implications for the Treatment of Depression,” American Psychologist, Vol. 49, No. 12, pp.1003-1020 (1997)). According to Johnson, perfectionism raises levels of the stress hormone, cortisol, and chronically high levels of cortisol lead to various health problems, including depression. Id. And when we make the inevitable mistake, perfectionism magnifies the failure. "Perfectionists are more vulnerable to depression and anxiety, harder to treat with either therapy or drugs, and much more likely to commit suicide when things go very wrong." Johnson, Stress Management.

Less intuitive than the prevalence of perfectionism is the prevalence of pessimism among lawyers. A Johns Hopkins study in 1990 showed that in all graduate-school programs in all professional fields except one, optimists outperform pessimists. The one exception: law school. Richard G. Uday, That Frayed Rope, Utah State Bar J., Aug./Sept. 2003. As Uday points out, pessimism helps us excel: it makes us skeptical of what our clients, our witnesses, opposing counsel, and judges tell us. It helps us anticipate the worst, and thus prepare for it. But pessimism is bad for our health: it leads to stress and disillusionment, which make us vulnerable to depression.

How can you distinguish depression from ordinary sadness? Here are the classic symptoms:

Diminished interest or pleasure in most activities.

Significant weight loss or weight gain without effort, or loss of appetite.

If you think you might have depression, get help. Talk to your family doctor; after all, depression is a health problem. And don't be ashamed or afraid of the treatment, whether it's antidepressant medication, therapy, or both. When treated, depression usually goes away. When untreated, it can kill you.

» Depression from Minor Wisdom
Depression is epidemic among lawyers. If you don't realize that, look at the numbers cited in my guest post on Evan Schaeffer's Notes from the (Legal) Underground. One famous author dislikes the word depression. William Styron describes the word as [Read More]

Tracked on March 16, 2005 at 08:00 AM

» What does it all mean? from Mackenzie's Weblog
This post caused me to think about my life outside the law, and come up with things I'm passionate about. But doesn't this presuppose that law students are passionate about the law? I realize if we're not this may not be a great line of work for us, bu... [Read More]

» Just a Hungry Chicken in a Land of Stick-Monkeys from LearningToLoveTheLaw
I would really like to sound sympathetic, but I'm not. It is as if someone had told me that I would not really want to win a big lottery prize because the success would "change" me. I damned well DO want to win a lottery prize. . . . Here I am lookin... [Read More]

Tracked on March 18, 2005 at 08:54 AM

» Notes from the Legal Underground: Depression from Law in Hyperspeed
It is very common for someone with ADD to have comorbid depression. The medical world is unsure if this is just a natural part of the differences in the ADD brain or is caused by the constant situational stress caused by being an ADDer in a non-ADD w... [Read More]

» that sort of a day from Not for Sheep
It began with a small headache that grew into first happiness when I read Prof. Ward's piece on Evan's site, and then heartache when I followed one of the trackbacks. I started to respond on the individual's site, but then stopped. When you try to reas... [Read More]

Tracked on March 19, 2005 at 10:09 PM

» McMillian on Lawyer Depression and Media Depictions from Legal Profession Blog
Posted by Alan Childress Attorney depression and related mental health issues are a recurring topic on this blog and others (e.g., Mike's June 20 post on a Pennsylvania bar matter, and his this morning on a Missouri case involving bipolar [Read More]

Tracked on July 16, 2008 at 01:08 PM

Comments

Hold on there. If a law student goes to a doctor and complains about depression, they will hinder or stop their character and fitness review. (Lawyers are not subject to as close scrutiny.) In some states, at various times, it is an absolute bar.

Personally, I don't want people who see shrinks being lawyers. This raises too many confidentiality issues.

That is absolutely not true. What the Bar is looking for, when it comes to
character & fitness, are the folks who lie about their mental health
issues and try to cover them up. The more up front you are about your
mental health issues (and assuming you can prove that you have sought/are
seeking help for them and maybe are even trying medication), the less the
Bar cares. I speak from personal experience. They're not worried about the
law student who's on Welbutrin and attending a group therapy session once
a week. They're worried about the one who was committed to the hospital
after a suicide attempt who --oops--left that off the character and
fitness application.

Taint, you sound like a pessimist. Anyway, I don't see the connection between seeing a shrink and "confidentiality issues." Can you elaborate on that?

Actually, letting depression go untreated is the greater threat to professional responsibility. Lawyers who can't function will tend to mess up a lot more than lawyers who are on medication or in therapy.

Actually, Taint (good to see you back in the blogoverse, btw) some of the best trial lawyers I know are into that kookooroo psychodrama stuff. Getting in touch with your own psychological conflicts helps you better understand your own clients, and the other side.

Well, as a professional responsibilities prof (adjunct but looking for a permanent position and running the hell away from practicing) I always teach about the mental health impacts that come from the profession. Lawyering has the highest rate of drug and alcohol abuse too. Sucks to be us. I hope people read about it here. Great information. Thanks.
-Jennifer

So if 19% of lawyers suffer from depression, and 15% of the depressed commit suicide, therefore 3% of lawyers commit suicide. That should translate into 27 suicides at my 900-lawyer firm (not including alumni) and 5 suicides amongst my law school graduating class of 175.

Yet I don't know a single lawyer suicide. I suspect that 15% number is inflated.

"So if 19% of lawyers suffer from depression, and 15% of the depressed commit suicide, therefore 3% of lawyers commit suicide." Ted

Huh? I understand that, according to the National Institute of Mental Health, 15% of people with clinical depression commit suicide, not 15% of lawyers with depression. Lawyers are not people, generally. I suspect that the 15% could be accurate, but that lawyers with depression might have a lower incidence of suicide than the aggregate of all people with clinical depression. Then again, it's possible that the benefits of working at Ted's 900-lawyer firm are sufficient reasons for a depressed lawyer there not to commit suicide. Maybe there is a higher incidence of suicide among depressed lawyers in private practice, small firms, or unemployed. Or, the 15% could be inflated.

OTOH, as I don't want to minimize Ray's point -- Most state bar proceedings note that the disciplined lawyer was suffering from extreme depression or drug dependency (re: self-medicating instead of being treated for depression-related conditions).

So, while depressed lawyers might not be killing themselves, they sure are hurting clients, and they are killing their careers and reputations.

Suicide itself may be underreported, due to the stigma. The obituaries in the local newspaper often say that the decedent died of "undetermined causes." I've often wondered whether "undetermined causes" is a euphemism.

the thing Taint wrote about the bar looking sideways at you (for lack of a better term) is absolutely not true. Before going in for treatment, I was terrified the bar would reject me because I had been diagnosed with depression.

Turns out, the bar does not care. (at least up north. Down here in the South, who knows what's happening... for myself: I am unashamed to disclose that I suffer from depression. I am not my disease. If anything, the fact that I am in treatment ought to reflect well on my character!)

As it is: I'm glad that I'm taking time off school to get better. So many things have improved (i.e. ability to concentrate, etc.) that taking time off is the best thing that happened to me.

I indirectly know two lawyers in my city who committed suicide in the past two years. (I actually did briefly know one of them, and blogged about his death a while ago). Only one of them was reported publicly as a suicide.

Ted's analysis is flawed. If 15% of people with clinical depression commit suicide, that statistic only tells us that suicide occurs at some point in the depressed person's lifetime. Ted should track his 171 clinically depressed lawyers (19% of 900) over the course of their entire lifetimes to see whether 27 of them die of suicide, before dismissing the statistic. Suicide and depression are particularly prevalent among the elderly, so the numbers may be skewed if Ted's law firm colleagues haven't yet reached their golden years.

Thanks, UCL, but I did account for the passage of time in my analysis. I didn't say 27 suicides a year. I've been practicing at law firms for ten years, and there's been precisely one death of a practicing attorney, a partner who died young of cancer a few years after I left that law firm. I don't think that was a suicide, but give her the benefit of the doubt. The average life expectancy of a practicing lawyer is 40 years or less (probably closer to 30), so I should've seen at least a quarter of the 27 suicides the model predicts. And, of course, if we account for turnover, there have been at least 3000 lawyers who have been at the same law firm I've been at, so there should be a couple of suicides a year among current or former attorneys at these law firms. Five classes of ~175 people were in law school with me; the model predicts 15 of them will commit suicide, and eleven years after I've graduated, none of them have.

You perform a shift in the opposite direction by expanding the universe to "lawyers in my city." If it's a large city, there are a few thousand lawyers in it, and over 100 of them are expected to commit suicide if the 15% number is true.

That 15% number is huge. That's the equivalent of having every attorney roll a pair of dice once, and saying each one that rolls box-cars will be a suicide. Rolling box-cars is considerably less uncommon than lawyer suicides. Trying to back-end it to say that most of those are committed by the elderly both (1) shows that the original problem is exaggerated, because elderly retired lawyers are not who Mr. Ward was talking about, and (2) requires that virtually every depressed lawyer suicide be amongst the elderly.

Ted, your analysis is flawed in several respects. The article says “15% of people with clinical depression commit suicide”. It doesn’t say when. As to your law school classmate data, depression is much more common in the elderly, so actual deaths would be skewed with age. Young lawyers (and 10 years of practice is young) would not be statistically relevant to the general population of lawyers in this regard. There are plenty of successful lawyers that live with their depression for many years before burn-out or worse.

As to your personal observations of “3000 lawyers”, “counting turnover”, those numbers are probably skewed as well, since I would expect a much larger turnover figure during the first 15 years of practice with a firm (which will necessarily weight the population mix toward younger lawyers). Additionally, suicide carries with it a stigma, and often families will keep the fact of a family member’s suicide confidential. It would not be unusual for partners at a law firm to do the same about their brethren. Additionally, many lawyers will drop off the radar screen before the depression reaches the point of suicide.

I don’t think you literally mean an “average life expectancy of a practicing lawyer is 40 years or less …” Most lawyers I know live well beyond age 40. I assume you mean the actual years of practice of the average lawyer are 40 years or less. That may be more or less accurate. 30 years are not unless you count lawyers that change careers (perhaps as a result of depression?).

Even if one were to assume your own numbers were correct, statistics are subject to the "law of large numbers". Your one personal observation is not that significant. It’s like saying the chances of flipping a coin on a single toss and getting a head can’t be 50% because when you do it five times in a row they all turn out to be tails. The probability of that 5-flip trial ending up tails 5 times is approximately 3% (.5 raised to the fifth power), which, by the way, is closer to the chances of rolling “boxcars” (1/36 = approximately 3%) than the 15% you attribute to that probability.

I have practiced over 20 years and have known plenty of clinically depressed lawyers, some of whom are still very “successful” in their carreers, but with very dysfunctional personal and family lives. And yes, I have known lawyers that have committed suicide, as well.

DL, when I say the average life expectancy of a lawyer is less than forty years, I'm saying the average lawyer has less than 40 years to live, not that the average lawyer keels over at the age of 40. Someone who would've gone to law school, but commits suicide at 18 doesn't count as a lawyer suicide. We're rather talking about a group of people who become lawyers at age 24 or later, many in their 30s or even 40s. If 3% of them eventually commit suicide, that's 1 suicide for every 1200 lawyer years.

There's a difference between flipping a coin tails five times in a row and rolling dice 3000 times without getting boxcars once; the first is within the range of a couple of standard deviations; the second isn't. The correct application of the law of large numbers does not support you. Rather, it says that, out of "I know 3000 lawyers, none of whom have committed suicide in the last ten years," "19% of lawyers are depresed" and "15% of depressed lawyers commit suicide," at least one of those three figures is false.

If you want to claim that it's the first figure that is false, I challenge you to name a Kirkland & Ellis attorney who has committed suicide since I summered there in 1993.

If the claim is that these depressed lawyers don't actually become depressed and suicidal until they're elderly, I submit that the problem is not anywhere near as severe as the original post suggested, since the article did nothing to qualify its claims by saying that it wasn't talking about recent law school graduates, or lawyers with big firms, etc.

I challenge the claim that elderly are more likely to commit suicide: only 0.3% of deaths of those 65 or older are from suicide, and suicide is most common in the 35-44 cohort, followed by 45-54 and 25-34.

This is a very important discussion, and it highlights issues that need to be explored. I work for the New Jersey Lawyers Assistance Program, a free, confidential program working with attorneys, judges, law students and law graduates dealing with addictions, depression, stress and other personal problems. Most states have a program like ours and you can find a list at www.ConfidentialHelp.com . One excellent thing about Lawyers Assistance Programs is that several of them have counselors who are also attorneys, and for lawyers and law students to be able to speak to a counselor who also understands firsthand the rigors of a life in the law is a unique benefit these programs can offer. Keep in mind, too, that Lawyers Assistance Programs can connect lawyers, judges and law students in recovery to private, invitation only AA-type meetings just for them which many feel a special appreciation for. Some programs also offer other support groups including those for women attorneys and others for depressed attorneys. Contact your local program for specific information on their offerings.

You can also find a great deal of informative articles on our website, www.LawyersAssistance.org
including articles on coping with stress and depression in law school; the connection between stress, depression and substance abuse; personal stories of addiction and recovery written by attorneys and judges; personal stories of depression, coping and recovering from attorneys who have experienced it; information on co-dependence, addiction, depression, 12 step programs, stress, coping, and these issues as they relate to women in law as well as a variety of other related topics.

I also want to respond to a question raised back in March in this thread with regard to Character and Fitness Committees and how they may regard information about an applicant having sought out mental health services. Keep in mind that these committees have probably seen nearly *everything* including, on occasion, some fairly significant felony convictions. They are also aware of the very stressful nature of law school. Statistics on stress and depression throughout law school are significant and alarming. That one would recognize that they need to find an appropriate way to cope is a positive thing. So often we see people who self-medicate in law school and throughout their careers with alcohol, drugs or other deleterious addictive behaviors which can only serve to harm them and - potentially - their clients. Neglecting oneself - "toughing it out" - is a great way to burn out and find oneself needing even more help than they did initially.

Getting help for depression is appropriate. If that includes medication, that, too is appropriate. Many people forget that depression is a medical disease just as heart disease or diabetes are diseases. All three need to be kept in check for a person to remain healthy. The difference is that there isn't a stigma attached to heart disease and diabetes as there unfortunately is with depression. Depression that is treated successfully is depression that is not creating significant personal and professional problems for the attorney. As far as fitness to practice, that should be a plus as opposed to unmedicated depression wreaking havoc on an attorney's personal and professional life (remember- some symptoms of depression include problems with memory, cognitive function and comprehension; confusion; procrastination including file stagnation - inability to open mail, answer phones/phone messages/speak to clients; a profound sense of being overwhelmed; a general sense of apathy, insomnia, exhaustion, inability to get out of bed at times (there's more on our website written by lawyers who have experienced it.)

To get personalized answer for your state, though, go to www.ConfidentialHelp.com and look up the Lawyers Assistance Program for your state and contact them confidentially to discuss your concerns. If you prefer, you should be able to correspond via e-mail as well.

In New Jersey we advise Law Students that if they know of anything (a DWI for example or any arrest or other infraction including but not limited to those committed under the influence of alcohol, drugs or prescription drugs used illegally) to contact Lawyers Assistance in advance of making application to the Committee on Character and discuss it with us as we have helpful resources.

Also keep in mind that no matter what is in your past that you feel may be problematic, it is necessary to report it honestly and completely, even if expunged as per the instructions on the forms. I've heard it said dozens of times - no matter what you have in your past, it's far worse to cover it up than to report it properly. Lack of candor is a grave concern. Your Lawyers Assistance Program can answer more specific questions for you.

PS: Just my personal opinion to Taint, who posted about not wanting people who see psychiatrists to be lawyers because it "raises too many confidentiality issues." I would suggest it does not. Between the attorney-client privilege and the doctor-patient privilege along with the 42CFR Confidentiality Rules I'd be perfectly comfortable. More than that, though, I'd much rather that the attorney handling my important business gets the appropriate help s/he needs as needed if for no other reason than that this will be a more functional attorney. The thought that the details of a case with names and specifics would be spilled in a 45 minute therapy session is highly unlikely.

I'm a law student and I can honestly say it is really depressing. I study, but it's hard. If you work for 75 hours a week, your neighbor is studying 80. If you make a good argument, someone makes a good rebuttal and the professor just looks at you both like you have a booger on your face, which can be very embarrassing and stressful. If you run 20 miles an hour, the ambulance your chasing is going 25 miles per hour. Plus, most of your teachers are insane. Oy vey!

All I have to say is thanks for Rachelle and Kim for putting things in perspective. I don't think we need to get into all the semantics, you know, some of us are just looking for weblogs to make us feel better while we study away.... And this discussion about the loneliness and frustration throughout law school and beyond helps me, at least.

In response to some of the prior posts, at a major East coast law firm I worked at a few years ago, I know of one attorney who took his life while I was there. He was a partner at the firm and had a wife and kids. It was tough news to swallow.

At another major international firm where I worked, I know one very successful senior attorney who became addicted to crack, eventually losing his job, his marriage, and his kids.

As I tell my children, truth is actually evil and would destroy the world should it be told too often. It is true that most lawyers where I am self-medicate to the point of self-sedation every day (and more at night). The ones who don;t are the ones who actually have lost the ability to spot their own bullshit. The ones who do still think about things like justice, truth, fairness, conscience, etc. I like to tell my wife life is 99% psychology. The psychology of lawyering is crisis management for people either going through calamity or grasping at money or both. Without the need to make all that cash to keep the wife and kiddies under a nice roof and simultaneously keep all the self-medication going (the booze, pills, smoke, restaurants, booze and other distractions) it might actually be a good job. As it is the madatory cash snatching and political ass licking ruins the job, and the professional life. I used to fear death. Now I just fear becoming like those seventy year old guys I see in court each week who believe their own bullshit and can't let go because being a lawyer is all they have. Their personal identies are dead. Mine is headed there quick enough. I hope to hell I can get out while I still know right from wrong and have the guts to say so when it counts. Good fucking luck!